IMPORTANT NOTE: Please make every effort provide thorough information in this section, especially as certain conditions may be life threatening.

*Allergies (food, medications, other):

IMPORTANT: Please be sure to provide a complete list of current allergies, even if you have provided this information in the past.

*Allergy treatment

I will provide the school with an EpiPen, as my child's allergy could result in a severe, potentially life-threatening, reaction.

My child requires no special medication or treatment on site.

My child does not have allergies.

Medical conditions, other than allergies, about which the school should be aware:

Medication(s)

*MEDICAL

I hearby authorize the above physicians and/or their associates or assistants, or their covering physicians, or, in the event these persons cannot be contacted, the emergency physician to provide emergency medical treatment to my child for: a. any laceration, fracture, or other traumatic injury; or b. any symptom, disease, or injury that may be life threatening, disfiguring, or cause permanent impairment. No major surgery or life-threatening procedure may be performed on my child and no general anesthesia may be administered unless: a. The life or health of my child is in danger or if delaying such treatment to obtain consent would cause a threat or serious injury to the health of my child; and b. the attending physician and one other physician consult and agree that such a treatment is necessary for the health of my child.

*Medical Release Agreement

Please indicate that you understand and agree to the Medical Release by typing your name here.

SPECIAL NEEDS INFORMATION

Please indicate any special learning needs your child may have. The information you share will help us do our best in providing your child with a learning environment in which s/he may experience the greatest possible success.

ADD

ADHD

Autistic Spectrum Disorder

Dyslexia

Hearing Loss

Learning Disability

Visual Impairment

Other (Please explain in next section.)

More information here:

Use this space to provide any other information about your child/family that will help us meet your child's needs.

RELIGIOUS COVENANT

*Religious Covenant Agreement

It is the assumption and understanding of our congregation that children enrolled in our Religious School are brought up in the Jewish faith only and that there is no formal education in any other faith. If you have a question or concern about this matter, please contact Rabbi Gluck (RabbiGluck@TempleBethElNJ.org or 908-722-0674, ext 311) before submitting this form.

*Type your name here to confirm:

Please indicate that you understand and agree to the Religious Covenant by typing your name here.

IMPORTANT NOTE: Please make every effort provide thorough information in this section, especially as certain conditions may be life threatening.

Allergies (food, medications, other):

Please be sure to provide a complete list of current allergies, even if you have provided this information in the past.

Medical Conditions, other than allergies, about which the school should be aware:

Medication(s)

MEDICAL RELEASE

I hearby authorize the above physicians and/or their associates or assistants, or their covering physicians, or, in the event these persons cannot be contacted, the emergency physician to provide emergency medical treatment to my child for: a. any laceration, fracture, or other traumatic injury; or b. any symptom, disease, or injury that may be life threatening, disfiguring, or cause permanent impairment. No major surgery or life-threatening procedure may be performed on my child and no general anesthesia may be administered unless: a. The life or health of my child is in danger or if delaying such treatment to obtain consent would cause a threat or serious injury to the health of my child; and b. the attending physician and one other physician consult and agree that such a treatment is necessary for the health of my child.

Medical Release Agreement

Please indicate that you understand and agree to the Medical Release by typing your name here.

SPECIAL NEEDS INFORMATION

Please indicate any special learning needs your child may have. The information you share will help us do our best in providing your child with a learning environment in which s/he may experience the greatest possible success.

ADD

ADHD

Autistic Spectrum Disorder

Dyslexia

Hearing Loss

Learning Disability

Visual Impairment

Other (Please explain in next section.)

More information here.

Use this space to provide any other information about your child/family that will help us meet your child's needs.

RELIGIOUS COVENANT

It is the assumption and understanding of our congregation that children enrolled in our Religious School are brought up in the Jewish faith only and that there is no formal education in any other faith. If you have a question or concern about this matter, please contact Rabbi Gluck (RabbiGluck@TempleBethElNJ.org or 908-722-0674, ext 311) before submitting this form.

Religious Covenant Agreement

Please indicate that you understand and agree to the Religious Covenant by typing your name here.

IMPORTANT NOTE: Please make every effort provide thorough information in this section, especially as certain conditions may be life threatening.

Allergies (food, medications, other):

Please be sure to provide a complete list of current allergies, even if you have provided this information in the past.

Allergy treatment

I will provide the school with an EpiPen, as my child's allergy could result in a severe, potentially life-threatening, reaction.

My child requires no special medication or treatment on site.

My child does not have allergies.

Medical Conditions, other than allergies, about which the school should be aware:

Medication(s)

MEDICAL RELEASE

I hearby authorize the above physicians and/or their associates or assistants, or their covering physicians, or, in the event these persons cannot be contacted, the emergency physician to provide emergency medical treatment to my child for: a. any laceration, fracture, or other traumatic injury; or b. any symptom, disease, or injury that may be life threatening, disfiguring, or cause permanent impairment. No major surgery or life-threatening procedure may be performed on my child and no general anesthesia may be administered unless: a. The life or health of my child is in danger or if delaying such treatment to obtain consent would cause a threat or serious injury to the health of my child; and b. the attending physician and one other physician consult and agree that such a treatment is necessary for the health of my child.

Medical Release Agreement

Please indicate that you understand and agree to the Medical Release by typing your name here.

SPECIAL NEEDS INFORMATION

Please indicate any special learning needs your child may have. The information you share will help us do our best in providing your child with a learning environment in which s/he may experience the greatest possible success.

ADD

ADHD

Autistic Spectrum Disorder

Dyslexia

Hearing Loss

Learning Disability

Visual Impairment

Other (Please explain in next section.)

More information here.

Use this space to provide any other information about your child/family that will help us meet your child's needs.

RELIGIOUS COVENANT

It is the assumption and understanding of our congregation that children enrolled in our Religious School are brought up in the Jewish faith only and that there is no formal education in any other faith. If you have a question or concern about this matter, please contact Rabbi Gluck (RabbiGluck@TempleBethElNJ.org or 908-722-0674, ext 311) before submitting this form.

Religious Covenant Agreement

Please indicate that you understand and agree to the Religious Covenant by typing your name here.

IMPORTANT NOTE: Please make every effort provide thorough information in this section, especially as certain conditions may be life threatening.

Allergies (food, medications, other):

Please be sure to provide a complete list of current allergies, even if you have provided this information in the past.

Allergy treatment

I will provide the school with an EpiPen, as my child's allergy could result in a severe, potentially life-threatening, reaction.

My child requires no special medication or treatment on site.

My child does not have allergies.

Medical Conditions, other than allergies, about which the school should be aware:

Medication(s)

MEDICAL RELEASE

I hearby authorize the above physicians and/or their associates or assistants, or their covering physicians, or, in the event these persons cannot be contacted, the emergency physician to provide emergency medical treatment to my child for: a. any laceration, fracture, or other traumatic injury; or b. any symptom, disease, or injury that may be life threatening, disfiguring, or cause permanent impairment. No major surgery or life-threatening procedure may be performed on my child and no general anesthesia may be administered unless: a. The life or health of my child is in danger or if delaying such treatment to obtain consent would cause a threat or serious injury to the health of my child; and b. the attending physician and one other physician consult and agree that such a treatment is necessary for the health of my child.

Medical Release Agreement

Please indicate that you understand and agree to the Medical Release by typing your name here.

SPECIAL NEEDS INFORMATION

Please indicate any special learning needs your child may have. The information you share will help us do our best in providing your child with a learning environment in which s/he may experience the greatest possible success.

ADD

ADHD

Autistic Spectrum Disorder

Dyslexia

Hearing Loss

Learning Disability

Visual Impairment

Other (Please explain in next section.)

More information here.

Use this space to provide any other information about your child/family that will help us meet your child's needs.

RELIGIOUS COVENANT

It is the assumption and understanding of our congregation that children enrolled in our Religious School are brought up in the Jewish faith only and that there is no formal education in any other faith. If you have a question or concern about this matter, please contact Rabbi Gluck (RabbiGluck@TempleBethElNJ.org or 908-722-0674, ext 311) before submitting this form.

Religious Covenant Agreement

Please indicate that you understand and agree to the Religious Covenant by typing your name here.

A deposit is due at the time of registration. School deposit is $100 per child, with a maximum of $200 for two or more children. Please note that registration will be processed once your deposit is received. Your deposit will be applied to tuition.

*Enter the amount of your registration deposit.
$

Religious School Scholarship Fund
$

Please consider making a contribution to the Religious School Scholarship Fund to help offset tuition costs for temple families in need.
If you're paying by credit card, please note your contribution here.

Your financial commitments to the temple must be current in order to process registration. If you need to make a special arrangement, please contact Amy Rubin, Executive Director, 908-722-0674, ext 310. Any information you share will be held in the strictest confidence.

Submit your registration by clicking the button below. When completed, you will see a confirmation screen. Remember, the session will timeout and data will be lost should your session take longer than 15 minutes.

Account Details

Enter your name and e-mail address for your confirmation:

*E-mail

*First Name

*Last Name

Payment Information

Account

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Checking Account

Name on the Account

Bank Name

Routing Number

Is usually located between the
symbols on your check.

Account Number

Typically comes before the
symbols. Its exact location and number of digits varies from bank to bank.